Wednesday, April 16, 2014

Consumer Driven Healthcare - Where is it Going?

After I read Red Humors blog on Open Notes, I struck up a discussion with a radiologist friend. We commiserate over laws and loopholes in laws that cause system abuse. I am so happy that Obama recommended to close the loophole in the Stark Law in his 2015 budget. That loophole has created some rampant abuse.

I worry about and applaud the possible effects of patients being able to read their notes online. We doctors need our own forum to make notes without worrying about hurting our patient's feelings. But patients also need to be able to review the discussion in the doctor's office in their own space, with all of their mental focus. Open Notes seems like a step in the right direction, but not entirely. We need two spaces. One for the patient, and one for the doctor.

When I was in CT, waiting on a specimen from the lung to review, I was telling the radiologist about Red Humor's blog topic. He told me that there is a push to the radiologists for the patient to be able to see their diagnosis online, as soon as it is available, before they have even discussed it with the clinician.


I wrote a post here before, called Poker Face. In a nutshell, it was about me accidentally conveying during fellowship a patient's negative diagnosis by delaying my answer too long when being probed directly by the patient. It was an excruciating experience that taught me to use expert words to delay the fact that I knew someone's cancer had returned or was diagnosed or had metastasized. After all, I am just a pathologist. I have no treatment options or good perspective on prognosis and treatment. That is Red Humor's job, not mine.

The radiologist worried, as I do, that all the great tools and information that our oncologists and clinicians have to offer a patient will not be there, in the privacy of their own home, while they are reading the ominous information. He worried aloud that the information might overwhelm them. As he was saying that he mimed a gun to his head. I completely agree.

There is way too much misinformation out there on the internet and you need an educated professional to reassure and guide you through it. I depend on my mechanic to fix my car. I depend on my accountant to do my taxes. As doctors, our patients need to depend on us to pick them up when all seems lost.

Last week the New York Times released a big article allowing patients to look up how much their doctors received from Medicare over the last year. It's telling information, but muddy. We doctors enjoyed googling each other to find out who is getting what. Pathologists are at the bottom of the list. If you consider Medicare reimbursement is about 30% of overall practice (in conjunction with private insurance), the information is not enough. It's a step in the right direction, but like many steps mentioned above, it falls short.

I see the need for change in healthcare. But the problems are multifactorial, and it will take lots of time and energy to fix them. In the meantime, let's try to keep a proper perspective to protect our patients. Let's delve back into the reasons we went into medicine in the first place. To help people, to protect and serve. Don't give them information in the privacy of their own homes that they aren't equipped to deal with, or anything that might hurt their feelings. That's a nasty can of worms that doesn't need to be opened.


  1. I think the issue of how to disclose information to patients is a diffcult one. Similar to the issue you brought up with radiology, our patients now want their tumor markers released along with the rest of their labs, which means they would be able to see a rising ca-19 or ca-125, sometimes before we do. I feel like whenever we try to push back against patients getting the raw data (and I am also thinking of the the open notes issue) we are accused of being patronizing or deceptive- but the issue is exactly as you put it.. many times the patient would benefit from "data" in this form being put in the right perspective or, if the information is really bad news, hearing it in the office where we can be there to support them through it.

    healthcare is changing.. patients are demanding more transparency and access to their records, labs, radiology, etc. I think part of that access will mean they can find themslves on their own when it comes to interpreting it all.

  2. Hi,An insurance mandate is the best thing she can come up with?? Oh, christ! Singapore is number 6 in the WHO study, and their system is pretty damn private, esp. with medical savings accounts for all citizens. And yet, she says you should be forced by law to buy insurance?? Calling yourself a free-market economist but saying that we should be forced by gov't to buy a certain good makes no sense to me. Really? That's the ONLY way she can think of to make it "consumer-driven"?Thank you!!
    majakel-iso 13485


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